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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wv.,w.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br />---1 1-0 <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT <br />3 0 R0 '— -A 1004 113 006000l I M0-70c? -0 <br />LEGA LOT NO. BLOCK i (RACT OR SUBDIVISION It <br />DESC. <br />PHONE <br />OWNER ADDRESS CITY2IP <br />C�C]"OTENANTNAAME p.NTAC11_OR(jPERMIT S�t�1e a`D1�L'34061DF)lrr1,�2D3RD0- �46D-3 <br />EdAILmUD �\ <br />IP <br />CONTRACTOR gAD <br />Y5F wyA 4 I4 , ,i <br />_bb1�NM <br />J 1j <br />CONTR. LICENSE# <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />1\ho1.- .1 A 44" [1'^ SO.YVI(iv . I Electric _Gas_ Other I ��Cj�, a0 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO, TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Toilet <br />Bathtub <br />Lavatory (wasf , basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />_. <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />Water heater <br />Sink (service/barlmop/etc.) <br />Backflowpreventer <br />Urinal <br />T_ <br />Exh_ l fan <br />Heat pump <br />Heat p <br />Unit heater <br />Boiler <br />_ <br />_ <br />Drinking Fountain <br />ReirigeBo <br />liGn <br />Floor drain <br />Grease trap <br />_ <br />WoDdsto <br />Other oVAr l <br />Other V <br />_ <br />_ <br />Roof drains <br />Other_ <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of wcrk will be complied with rhether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />ca truction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />t ' Contractors Law 16.27 ROW and 296.200 WAG. <br />IAiv � 3' b <br />Si lure of Owner/ContractorlAulhorized Agent ate - I <br />VI ti <br />